THE “GOOD” CAREGIVER: DOES FILIAL PIETY NECESSITATE SELF-SACRIFICE?

Abstract Family caregiving policies that amplify the enactment of ‘filial piety’ – respect and care towards parents, grandparents and older persons – are especially pronounced in Asian societies, where caring for older family members is culturally expected and appraised yet is associated with stress and burden. Numerous studies have shown that fulfilment of filial piety contributes to better psychological outcomes for caregivers while mismatched filial expectations contribute to poorer psychological outcomes. However, few studies acknowledge how filial care varies according to individual resources and socio-cultural contexts. We seek to understand how family caregivers negotiate their self-determination through filial care, which contributes to positive and negative caregiving experiences. We conducted in-depth interviews with 34 caregivers of older persons with functional limitations in Singapore, purposefully selected based on varying positive and negative caregiving experiences. For caregivers with predominantly negative caregiving experiences, filial care was seen as an act of sacrifice and expectation of duty, with low autonomy to exercise self-determination. In comparison, caregivers with predominantly positive caregiving experiences described filial care as an act of sincere love cultivated through close relationships with their care-recipient, and aligned to their self-determination. Strong family support was also evident in the latter. Treating filial piety as a ‘natural desire to care for parents’ obscures efforts required to amplify positive caregiving experiences while normalisation of self-sacrifice and suffering hinders caregivers from expressing burden and accessing support. A nuanced understanding of how caregivers negotiate filial care can inform policy interventions to empower caregivers and care-recipients and enhance intergenerational relationships.

and ramps, and placement of hospital beds at home, etc.that change living arrangements and routines.Care tasks, responsibilities, and decisions are marked by negotiations, tensions, and compromises between people and with things.Caregivers appropriate, adapt, and improvise in situations of uncertainty, conflict, and impossible demand.We conclude that new socio-material arrangements of people, activities, and things that emerge because of caregiving change/disrupt the notion of home as a place of safety, familiarity, and comfort for caregivers.Understanding the emplacement/displacement and interconnection of things, activities, and people sheds light on how the home shapes the effects of caregiving and vice versa.

PATTERNS OF FAMILY CAREGIVING FOR OLDER ADULTS: THE ROLES OF PRIMARY AND SECONDARY CAREGIVERS
Rahul Malhotra, Jeremy Lim-Soh, Pildoo Sung, and Ha-Linh Quach, Duke-NUS Medical School, Singapore, Singapore Family members are often front-line carers for older adults.With research studies focusing largely on the primary family caregiver, less is known about how caregiving responsibilities are shared between family members.Using latent class regression, we described the prevalence of distinct patterns of family caregiving for older adults, in terms of who (division of assistance between the primary caregiver and secondary caregivers) provides what assistance (three types: with (a) activities of daily living; (b) health and social services; and (c) other socio-emotional needs), and their correlates.Primary family caregivers of 277 older adults (75 years and older) with functional limitations in Singapore, were interviewed in 2019-2020.Three patterns of family caregiving were identified.The 'Shared-Diverse' (43%) pattern typically involved multiple family caregivers providing all three types of assistance.The 'Shared-Informal' (27%) pattern also typically involved multiple family caregivers but no provision of assistance with health and social services; such care-recipients were more likely to be female (versus the Shared-Diverse pattern).The 'Solo-Diverse' (30%) pattern typically involved the primary family caregiver solely providing all three types of assistance; such caregivers were less likely to be working.Primary family caregivers in the Solo-Diverse pattern, versus the Shared-Diverse pattern, had higher depressive symptoms.The predominance of caregiving patterns involving multiple family members highlights the need for expanding family caregiving research, policies, and programs beyond primary family caregivers.The findings also underscore the importance of solo family caregivers, whose employment ability and mental health may be affected by their caregiving duties.

THE "GOOD" CAREGIVER: DOES FILIAL PIETY NECESSITATE SELF-SACRIFICE?
Ad Maulod, Sasha Rouse, Nur 'Atiqah Lee, and Rahul Malhotra, Duke-NUS Medical School, Singapore, Singapore Family caregiving policies that amplify the enactment of 'filial piety' -respect and care towards parents, grandparents and older persons -are especially pronounced in Asian societies, where caring for older family members is culturally expected and appraised yet is associated with stress and burden.Numerous studies have shown that fulfilment of filial piety contributes to better psychological outcomes for caregivers while mismatched filial expectations contribute to poorer psychological outcomes.However, few studies acknowledge how filial care varies according to individual resources and socio-cultural contexts.We seek to understand how family caregivers negotiate their self-determination through filial care, which contributes to positive and negative caregiving experiences.We conducted in-depth interviews with 34 caregivers of older persons with functional limitations in Singapore, purposefully selected based on varying positive and negative caregiving experiences.For caregivers with predominantly negative caregiving experiences, filial care was seen as an act of sacrifice and expectation of duty, with low autonomy to exercise self-determination.In comparison, caregivers with predominantly positive caregiving experiences described filial care as an act of sincere love cultivated through close relationships with their care-recipient, and aligned to their self-determination.Strong family support was also evident in the latter.Treating filial piety as a 'natural desire to care for parents' obscures efforts required to amplify positive caregiving experiences while normalisation of self-sacrifice and suffering hinders caregivers from expressing burden and accessing support.A nuanced understanding of how caregivers negotiate filial care can inform policy interventions to empower caregivers and carerecipients and enhance intergenerational relationships.

FEELING ALONE TOGETHER: LONELINESS IN OLDER ADULTS WITH COGNITIVE IMPAIRMENT AND THEIR CAREGIVERS WITH LOW MASTERY
Pildoo Sung 1 , Jeremy Lim-Soh 2 , and Angelique Chan 2 , 1. Hong Kong Baptist University, Hong Kong, Hong Kong, 2. Duke-NUS Medical School, Singapore, Singapore Loneliness can be contagious because lonely people tend to share their loneliness with others.According to this perspective, loneliness in older persons with cognitive impairment (PCI) may beget loneliness in their family caregivers.However, not all caregivers of lonely PCI experience loneliness.This may be because caregivers have buffering resources that mitigate the contagion of loneliness.Nevertheless, empirical evidence on whether and how PCI and caregiver loneliness are related is lacking.Therefore, we examined the association between PCI loneliness and caregiver loneliness, and the moderation role of caregiver mastery on this association.We used dyadic data from 135 PCI and their family caregivers in Singapore.Descriptive statistics and bivariate correlation showed that PCI reported higher levels of loneliness than their caregivers, and PCI and caregiver loneliness were weakly related.Multivariable regression showed that PCI loneliness was not associated with caregiver loneliness, taking other covariates into account.Nevertheless, we found that the interaction between PCI loneliness and caregiver sense of mastery was significant, such that PCI loneliness was significantly associated with caregiver loneliness when caregivers had low mastery.In conclusion, lonely PCI may share their loneliness with their caregivers, and this may lead to caregiver loneliness if caregivers have low mastery.Tailored interventions should be designed to reduce loneliness among PCI and their caregivers and improve caregiver mastery as a protective factor against the spread of loneliness between PCI and caregivers.

IT'S OVERWHELMING FOR EVERYBODY: EXPERIENCES OF DEMENTIA CAREGIVERS WHO AREN'T CLOSE FAMILY
Jane Lowers 1 , Ivree Datcher 2 , Michelle Delk 3 , Dio Kavalieratos 2 , Molly Perkins 2 , and Kenneth Hepburn 2 , 1. Emory School of Medicine,Atlanta,Georgia,United States,2. Emory University,Atlanta,Georgia,United States,3. Emory Rol,Atlanta,Georgia,United States One in three people with Alzheimer's or other dementias lives alone, without a spouse/partner or nearby children (i.e., is aging solo).Friends, neighbors, and extended family often assist with tasks that preserve independence, but most dementia caregiving literature, and theory, to date focuses on spousal or parent/child dyads for whom reciprocity, indebtedness and self-interest are common motivators.This study seeks to address this knowledge gap.Design: Semi-structured interviews with caregivers of adults with cognitive impairment or dementia who were not the caregivers' spouses or parents.Hybrid inductive/deductive thematic analysis incorporating social exchange and stress-coping theories.
Results: We interviewed 11 caregivers (100% female; age 54-85, mean 71; 91% white, 9% black; 27% friend; 27% church congregant; 27% sibling or in-law; 18% neighbor).Caregivers described altruism, empathy, and, in cases of extended family, duty as motivators to provide care for acquaintances with dementia.Caregivers who themselves lacked close family identified with their care recipient's vulnerability and the possibility of needing similar care someday.Non-family caregivers described feeling unprepared and unqualified to make legal, financial, and guardianship decisions and looked to care recipients' distant family, health care providers, and religious leaders to guide decisions that require balancing care recipients' safety and autonomy, such as moving to a nursing home.
Conclusion: Dementia caregiving outside spouse or parent/child dyads can produce practical and emotional challenges for caregivers who are not immediate family.These caregivers may benefit from guidance about practical and ethical decisions in the absence of immediate family decision makers.